Provider Demographics
NPI:1275567893
Name:RIVERA-MARTINEZ, NELSON (RPT)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:RIVERA-MARTINEZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 CALLE PARABUEYON
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3177
Mailing Address - Country:US
Mailing Address - Phone:787-851-3402
Mailing Address - Fax:
Practice Address - Street 1:96 CALLE MCKINLEY W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3826
Practice Address - Country:US
Practice Address - Phone:787-834-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist